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HHS Conditions Hospital COVID-19 Relief Payments On No Surprise Billing

HHS Conditions Hospital COVID-19 Relief Payments On No Surprise Billing

Source : Medtech Insight

The US Department of Health and Human Services is withholding government Provider Relief Funds from hospitals that hire out-of-network anesthesiologists, pathologists and radiologists who attempt to sock COVID-19 patients with surprise bills for their care, says a 29 July HHS report.

The HHS’s Office of the Assistant Secretary for Planning and Evaluation detailed several initiatives in the report that the agency has taken to cut off Provider Relief Funds that were provided under coronavirus relief bills passed in the spring. The funds – enacted under the Families First Coronavirus Act (as amended by the Coronavirus Aid, Relief and Economic Security [CARES] Act) include millions of dollars distributed to hospitals, clinics and other providers to make up for lost revenues, provide care to coronavirus patients, and to keep their facilities operating while the public health emergency continues. ("COVID19 Hot Spots In US To Receive 5Bn To Test Nursing Home Residents Staff" "Medtech Insight" )

A section of the CARES Act requires health care plans and health insurers to reimburse providers of COVID-19 diagnostic testing at rates that equal the case price for such services, the HHS says. Further, in implementing the Provider Relief Funds, the HHS made certain that those who received the funds signed agreements stating they wouldn’t seek out-of-pocket payments from COVID-19 patients.

The HHS noted that surprise billing is a “widespread and costly problem” that has continued even during the pandemic, despite a lot of negative publicity surrounding the practice and legislation proposed to address it that emerged in 2019 and was consolidated earlier this year. ("Congress Tackles Overpriced Surprise Medical Bills Taking Several Different Tacks" "Medtech Insight" )

“This administrative action protects patients with an actual or presumptive case of COVID from being charged out-of-pocket expenses more than they’d be required to pay by an in-network provider.” – US HHS

The agency said there is a risk some COVID-19 patients will be treated by providers outside of their network during the current public health emergency, so it has placed restrictions on the ability of providers receiving assistance from the Provider Relief Fund to surprise-bill patients. The HHS added that surprise billing almost always involves a facility’s ancillary providers, “such as a hospital’s emergency room personnel, anesthesiologists, pathologists and radiologists.”

“This administrative action protects patients with an actual or presumptive case of COVID from being charged out-of-pocket expenses more than they’d be required to pay by an in-network provider,” says the report, which added that “Congress needs to enact a permanent solution to protect patients from surprise billing,”

Reacting to the report, a coalition of congressional leaders that have passed anti-surprise-billing legislation within their committees said they also believe Congress should act. The leaders say they’ve agreed on a transparent solution and legislative package that will lower patients’ premiums and not interfere with strong state protections against high-cost billing.

The coalition says it’s made up of both progressive Democrats and conservative Republicans, including House Energy and Commerce Committee chair Frank Pallone (D-NJ) and ranking member Greg Walden (R-OR), and Senate Health, Education, Labor and Pensions Committee chair Lamar Alexander (R-TN) and ranking member Patty Murray (D-WA).

“Patients have demanded protection from surprise medical bills for years, and they also need it in the middle of a global pandemic,” the coalition said in a statement. “It’s time for Congress to solve this problem for the American people.”

By Sue Darcey